| NPI | 1720082241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-20171) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 21317) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OK 24188) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2013-04-04 |